From the Guidelines
Transitional cell carcinoma (TCC) should be classified according to the World Health Organisation (WHO) classification, which divides tumors into high and low grade based on the latest WHO criteria 1. The classification of TCC is crucial for determining the appropriate management strategy and predicting patient outcomes.
- The WHO classification is the most widely accepted and used system for classifying TCC, and it is based on the tumor's grade and stage.
- The grade of the tumor is determined by the degree of cellular differentiation, with high-grade tumors showing significant cellular disorganization and nuclear atypia, and low-grade tumors showing minimal architectural and cytological abnormalities.
- The stage of the tumor is determined by its invasion depth, with non-muscle invasive bladder cancer (NMIBC) including Ta, T1, and carcinoma in situ (CIS), and muscle-invasive bladder cancer (MIBC) including T2, T3, and T4.
- The WHO/ISUP system uses a two-tiered classification (low and high grade), which is preferred over the older WHO 1973 system that used a three-tiered approach (G1, G2, G3) 1.
- Risk stratification combines stage, grade, size, number of tumors, recurrence pattern, and presence of CIS to categorize patients as low, intermediate, or high risk, which guides treatment decisions.
- Accurate classification of TCC is essential for determining the best course of treatment, including transurethral resection, intravesical therapy, radical cystectomy, or systemic treatments, and for predicting patient outcomes 1.
From the Research
Classification of TCC
The classification of Transitional Cell Carcinoma (TCC) is crucial for determining the optimal therapy and predicting the recurrence and progression of the disease.
- The staging of TCC has evolved over time and currently, the TNM classification is considered the gold standard 2.
- The TNM classification takes into account the tumor size, grade, and depth of invasion, as well as the presence of lymphovascular invasion 2.
- Accurate staging of TCC is necessary for designing optimal therapy and predicting the recurrence and progression of the disease 2.
Staging and Grading
- The grading and staging of TCC can be performed using transurethral resection of the bladder (TURB) specimens, but this may not always be accurate 3.
- The histologic grade of TCC is an important prognostic factor, with high-grade tumors having a higher risk of recurrence and progression 3, 4.
- The depth of lamina propria invasion is also an important prognostic factor, with deeper invasion associated with a higher risk of recurrence and progression 4.
Treatment and Management
- The treatment of TCC depends on the stage and grade of the tumor, as well as the patient's overall health and preferences 4, 5.
- For early-stage TCC, transurethral resection and intravesical therapy with bacillus Calmette-Guerin (BCG) may be effective in preventing recurrence and progression 4, 5.
- For more advanced TCC, radical cystectomy may be necessary, but this can be avoided in some cases using trimodality therapy with transurethral resection, chemotherapy, and radiation 6.
- Lifelong cystoscopic surveillance is necessary for patients with TCC, even after successful treatment, due to the risk of recurrence and progression 6.